This study used a scoping review design, following the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). ¹⁶ In addition, this study obtained ethical approval from the Medical and Health Research Ethics Committee of the Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada–RSUP Dr. Sardjito, with the number: KE/FK/0420/EC/2026.

The problem identification in this study used the PCC (Population, Concept, Context) approach. ¹⁷ The population was children under 5 years old, a group at risk of growth impairment. The concept focused on the determinants of stunting in the context of climate change. The context encompassed the global level, particularly low- and middle-income countries and climate-vulnerable regions. Based on the PCC framework, this study aims to identify and map the determinants linking climate change to stunting among children under five and their implications for community health practice. This study addresses three main questions: (1) what are the main determinants that link climate change with stunting, (2) how climate change affects the nutritional status and growth of children, and (3) what the implications for community nursing practice and public health interventions are.

The inclusion criteria in this study included: (1) studies that discussed the relationship between climate change and the incidence of stunting among children under five; (2) articles that identified determinants or mediation/moderation pathways that linked climate change with child nutritional status; (3) studies that included aspects of practice or policy in addressing stunting due to climate change; (4) original research articles with quantitative, qualitative, or mixed methods designs; (5) available in full-text access; (6) were published within the period of January 2016 to January 2026; and (7) written in English. Meanwhile, the exclusion criteria included: (1) articles that only discussed stunting without any association with climate change; (2) studies that focused on traditional interventions without relevance to environmental or community contexts; and (3) non-scientific articles such as editorials, commentaries, or narrative reviews that did not present primary data or systematic synthesis.

The article search was conducted by three researchers (A, AA, MAZ) using predetermined criteria, with reference to the PCC components. The search strategy was carried out in three stages: an initial search in at least two relevant online databases, followed by analysis of keywords and index terms from the initial results to refine the search strategy and make it more comprehensive across all identified databases. The search was conducted in January 2026 through the PubMed, ScienceDirect, Scopus, ProQuest, and Web of Science databases using Boolean operators (AND/OR) to combine relevant keywords. In addition to database searching, a general web search was performed through search engines (e.g., Google Scholar) and other sources of grey literature. This step aimed to identify potentially relevant studies that were not indexed in the selected databases, thereby enhancing the comprehensiveness of the evidence base. The keywords included topics related to stunting and child growth problems, as well as environmental aspects such as climate change, food security, and sanitation. The combination of keywords was adapted to each database’s system. The third stage included screening the reference lists of all selected sources to identify additional relevant studies. ¹⁸

Two researchers (EHHS and BTBR) independently conducted data extraction from the included studies. The data collected included study characteristics such as title, authors, year, objectives, location, design, type of climate change, and results. All data were then summarized and analyzed in accordance with the study objectives and presented according to the themes identified in Table 2.

Thematic synthesis was used to analyze data from the studies included in the review process inductively. ¹⁹ This process consisted of three stages: coding the extracted data, grouping into descriptive themes, and developing analytical themes that extended beyond the findings reported in the original studies.

The quality appraisal of articles in this integrative review used the critical appraisal tools from the Joanna Briggs Institute (JBI) to assess cross-sectional ²⁰ and cohort study designs. ²¹ The results of the critical appraisal assessment are presented in Table 1 below.

Two independent researchers (AA and DAN) conducted the identification and screening process using the Rayyan AI tool. In the initial stage, a total of 5,113 articles were identified from five main electronic databases, namely PubMed, ScienceDirect, Scopus, ProQuest, and Web of Science. In addition, manual searching (hand searching) was conducted on Google Scholar and other relevant websites, yielding an additional 7 articles; 3 of these were excluded because they were not focused on child stunting. Subsequently, the initial screening was conducted on 763 articles based on titles and abstracts, with 346 excluded as non-original research, such as review articles, opinions, commentaries, and editorials. A total of 281 articles were then assessed for eligibility through full-text review; however, 275 articles were excluded for the following reasons: not relevant to the relationship between climate change and stunting in children (n = 191) and not directly discussing stunting or child growth disorders (n = 84). Lastly, 10 articles were included in this review, comprising seven from the main screening and three from manual searching. The entire process is presented in Figure 1, namely the PRISMA flow diagram.

To understand how climate change affected the incidence of stunting in children, a review of several empirical studies from various countries with varying levels of climate change exposure was conducted. These studies differed in research design, geographic scope, and the types of climate variables examined, including rainfall anomalies, extreme temperatures, and seasonal variations. Most studies used a cross-sectional design (n = 7), while several others used a cohort approach to strengthen causal relationships (n = 3). The main characteristics of each study, including title, authors, year, country, design, type of climate change, and key findings, are presented in Table 2.

This review analyzed evidence from seven studies that examined how climate change affected child malnutrition, particularly stunting, both directly through environmental exposures (such as temperature and rainfall anomalies) and indirectly through disruptions to economic systems and food security. These studies covered various geographic regions, including Sub-Saharan Africa, South Asia, East Asia, as well as global-level analyses. The following synthesis table ( Table 3) presents the main subthemes and codes from the reviewed studies to illustrate the core findings within each thematic category.

Temperature, rainfall, and anthropometry correlation, variations in climate determinants, particularly temperature and rainfall, have been shown to affect the incidence of stunting. A 1 °C increase in temperature was associated with a decrease in children’s LAZ scores. ^{22, 23} Variations in rainfall were also reported to increase the prevalence of stunting, ^{24– 26} more specifically, ²³ reported that a 1 mm increase in rainfall was associated with a 0.1 percentage point increase in stunting. These impacts could be reduced by the quality of health services. ²⁷ However, findings indicate that daytime temperatures above 35 °C are associated with reduced odds of stunting among children aged 2–5 years, ²⁸ likely due to differences in adaptive physiological responses at this age group.

Physiological mechanisms due to climate change, Exposure to both extreme heat and cold has been shown to cause physiological stress that disrupts child growth. ²⁹ Children have lower heat tolerance than adults; therefore, high temperatures increase the risk of dehydration, leading to a significant decrease in HAZ scores. ²³

Disruptions in food security, environment, and sanitation: Temperature and rainfall anomalies due to climate change are known to disrupt food security through reduced agricultural yields, degradation of soil quality, as well as decreased water availability, which affect child nutritional intake. ^{22, 23, 29} In addition, rainfall and season length affect food production levels through changes in aridity, which have implications for household food security. ²⁵ Variations in rainfall also affect food availability and community consumption patterns, particularly during lean seasons. ²⁴

Household economic changes: Climate change can lead to declines in the income of the poorest groups ²⁶ and contributes to increases in food prices relative to household income, thereby reducing families’ ability to access nutritious food. ³⁰ In addition, the impact of rainfall on stunting is affected by socioeconomic determinants, including households’ ability to obtain food from the market, which is highly dependent on financial conditions. ²⁴

Increased risk of infectious diseases and maternal health disorders: High temperatures are associated with an increased incidence of diseases such as diarrhea and malaria, as well as dehydration, which affect child growth and may even affect fetal growth during pregnancy. ^{23, 29} In addition, changes in rainfall, such as droughts and floods, can disrupt access to clean water and sanitation, thereby increasing the risk of infectious diseases and hindering child growth. ^{23, 26} Physiologically, exposure to extreme heat and cold can disrupt body systems, including changes in blood flow, increased blood viscosity, and an increased risk of infection, leading to preterm birth and impaired child growth. ³¹

Regional variations in the impact of climate change, Children in rural areas are more vulnerable to stunting due to a higher dependence on the agricultural sector, which is sensitive to climate change. ²² In addition, the impact of temperature changes on stunting also shows inconsistent patterns across countries, both for high and low temperatures. ²⁹ In a more specific context, the impact of extreme temperatures also differs across cities, indicating that regional contextual determinants determine the magnitude of climate-change-related stunting risk. ³¹

Multisectoral and locally contextualized adaptation policies: Climate-friendly policies are required to reduce the long-term impacts of climate change on child malnutrition, including through improvements in infrastructure, expansion of electricity access, strengthening of the education sector, and the development of adaptive agriculture. ²² In addition, stunting intervention policies need to be adjusted to local contexts, given that differences in socioeconomic and environmental conditions across regions can affect the effectiveness of interventions. ²⁹ On the other hand, strengthening primary health care systems also becomes an important component in responding to the impacts of climate change on child nutritional status, particularly through early detection and quick and sustained management of nutritional problems. ²⁷

Interventions for vulnerable groups (mothers and children): Nutrition interventions should be prioritized for vulnerable groups, particularly pregnant women and infants, and accompanied by strengthening women’s education to reduce vulnerability to the impacts of climate change. ²⁶ In addition, special protection for pregnant women and infants is important for addressing the impacts of climate change, as this group is at higher risk of health disorders and impaired nutritional status due to environmental pressures. ³¹

Environment-based health interventions, Public health strategies need to consider the impact of high temperatures on child growth, for example, through the provision of cooler housing. ²⁸ Climate change adaptation is also important to maintain food security and health, such as through food diversification and home gardening. ²⁴ In addition, stunting interventions need to consider climate determinants such as rainfall, temperature, and seasons, and be implemented equitably across regions. ²⁵

The studies above reflect that climate change has a very close relationship with stunting, operating through both direct and indirect pathways. There are also policy recommendations that can serve as a reference for formulating mitigation strategies. As one of the health problems that affects the long-term quality of life, addressing stunting is essential. Community health nursing needs to contribute to these efforts through the following steps.

Community health nursing practice must adopt cross-sectoral collaboration to integrate early warning systems for nutrition into primary health care. ⁵⁴ By understanding local climate patterns, Community Health Nurses can take anticipatory actions such as providing prophylactic supplementation or strengthening sanitation before periods of extreme climate, to prevent nutritional crises. This step positions Community Health Nurses as frontline actors in protecting human capital from the threats of the global climate crisis. ^{55– 57}

Health education is a key strategy in addressing the impacts of climate change on child stunting at the community level. Community nurses have an important role in increasing family awareness of the risk of stunting caused by climate change, both directly and indirectly. ⁵⁸ Health education that can be provided includes balanced nutrition for pregnant women and children, ⁵⁹ the promotion of good hygiene and sanitation practices, ⁶⁰ and supporting early detection of growth problems through routine monitoring. ⁵² In addition, improving health literacy and maternal education has been shown to reduce vulnerability to malnutrition related to climate change. ^{61, 62}

In addition to education, adaptation strategies are required to strengthen household resilience to climate change. ⁶³ Adaptation can be implemented through family-based practices, such as utilizing food resources, ⁶⁴ promoting home gardening, ⁶⁵ and adjusting daily behaviors according to seasonal and environmental conditions. ²⁴ These approaches have been shown to improve household food security and dietary diversity, which in turn affect child nutrition. ⁶⁶ Community nurses play a vital role in guiding families to anticipate climate variability, such as changes in temperature and rainfall, through adaptive behaviors and community engagement. ⁶⁷ Globally, community-based adaptation strategies are recommended to protect vulnerable populations, particularly pregnant women and children, from the health impacts of climate change. ^{68, 69} Therefore, health adaptation functions not only as a response mechanism but also as a preventive approach to reduce the risk of stunting in the context of climate change.

This study shows that climate change has a significant and complex relationship with the incidence of stunting among children under five through direct and indirect pathways. The direct pathways involve physiological stress and dehydration due to extreme temperatures and rainfall anomalies. Meanwhile, the indirect pathways are mediated by disruptions to food security, declines in household economic status, and increased risk of infectious diseases such as diarrhea and malaria. These findings emphasize that addressing stunting is no longer sufficient through conventional nutrition interventions alone, but must integrate climate change adaptation strategies. Community health nurses play a crucial role as frontline actors within primary health care systems, conducting early detection of malnutrition in climate-vulnerable areas, providing environmental health education to families, and advocating for climate-friendly, multisectoral policies to protect vulnerable groups (such as pregnant women and infants) from the long-term impacts of the environmental crisis.

This study also has several limitations. Although the initial search yielded a substantial number of articles, only a small proportion of studies specifically examined the relationship between climate change and stunting, as well as its policy implications, indicating that this topic remains an emerging field that requires further investigation. In addition, restricting the review to English-language articles may have resulted in the exclusion of relevant studies published in other languages, particularly from developing countries that are significantly affected by climate change. The variation in study designs, which were predominantly characterized by cross-sectional approaches, also represents a limitation, as such designs are less capable of establishing strong long-term causal relationships compared to longitudinal or cohort studies. Finally, differences in geographical contexts across studies may affect the generalizability of the findings; therefore, their application to other regions should carefully consider local environmental conditions and healthcare system capacities.

This study has several key strengths. First, it employed a rigorous methodological approach by adopting the PRISMA-ScR framework alongside the PCC (Population, Concept, Context) strategy, ensuring that the process of literature identification and selection was conducted systematically and transparently. Second, this research offers novelty by specifically linking the issue of climate change to child nutritional status and its implications for community nursing practice an area that has thus far been relatively underexplored in an integrated manner. Third, the literature search was conducted comprehensively across five major international databases PubMed, ScienceDirect, Scopus, ProQuest, and Web of Science covering publications from 2016 to 2026, thereby ensuring that the evidence generated remains relevant to current conditions. In addition, the methodological quality of each included study was assessed using instruments developed by the Joanna Briggs Institute (JBI), which further strengthens the validity and credibility of the synthesized findings.